ASTHMA IN CHILDREN Flashcards
What is the differential diagnosis for wheezing in a child? For each diagnosis give a sign that might distinguish it from asthma.
Asthma
Cystic fibrosis - failure to thrive, productive cough, finger clubbing
Aspiration associated with gastro-oesophageal reflux - vomiting
Central airway disease - Inspiratory stridor with wheeze
Laryngeal problems - Abnormal voice
Inhaled foreign body - sudden onset
Postviral wheeze - recent URTI in children under 2
What features increase the probability that a wheezing child has asthma?
Episodes are frequent and recurrent
Worse at night or in the early morning
Occur in response to, or are worse after, exercise or other triggers such as exposure to pets, cold or damp air, or with emotions or laughter.
Occur even when the person has not got a cold (coryzal illness)
Another atopic disorder (hayfever, eczema).
Family history of atopy
Wheeze is widespread and bilateral
Prolonged expiration
Increased respiratory rate
You are a FY2 on a GP rotation. A mother presents to you with her 6 year old child Tim. You take a history and decide that there is a high probability that Tim is suffering from asthma. What should you do now?
Start Tim on a trial of treatment.
Explain difference between reliever and preventive therapy.
Take a baseline peak expiratory flow and compare it to his predicted.
What factors help determine what a child’s predicted peak flow should be?
Age
Height
Weight
BMI
Gender
Whether they have used a peak flow meter before
Children need to be six years or over to do a reliable peak flow. Additionally, if children have never used one before, a one-off reading when they are unwell will not be very reliable!
What is the first line management of chronic asthma in children regardless of age?
Salbutamol inhaler
You prescribe salbutamol inhaler with a spacer for Tim a 6 year old with newly diagnosed asthmatic. He comes back 3 weeks later. What are the indications for proceeding to the next step in the management of chronic asthma?
Having symptoms three times weekly or more
Awakening with symptoms one night a week or more
Having an exacerbation in the past 2 years
Using their inhaled beta2-agonist three times weekly or more
You prescribe salbutamol inhaler with a spacer for Tim a 6 year old with newly diagnosed asthmatic. He comes back 3 weeks later and his symptoms do not seem to have improved enough with the reliever. What is the next step in the management of chronic asthma in someone of his age group (5-12)?
Inhaled corticosteroids - beclometasone 200-400 micrograms per day normally across two doses
Tim is a 6 year old with asthma. He has a salbutamol inhaler and has recently been started on inhaled steroids. However, he is not tolerating these particularly well. What might you prescribe for Tim instead of the inhaled corticosteroids?
Leukotriene receptor antagonist - monteleukast.
Tim is a 6 year old with asthma. He has a salbutamol inhaler and is also on 200 micrograms of inhaled steroids BD. He comes back to surgery with his mother complaining that he is still experiencing some symptoms. What is the next step in the management of chronic asthma in someone of his age group (5-12)?
Consider starting Long-acting beta2-agonists (LABA) if symptoms are still uncontrolled when using an ICS at 400 micrograms/day.
Tim is a 6 year old with asthma. He has a salbutamol inhaler and is also on 200 micrograms of inhaled steroids BD. He was recently also given a LABA to try as he was still experiencing symptoms, however this doesn’t seem to have helped much. What is the next step in the management of chronic asthma in someone of his age group (5-12)?
Stop LABA, consider leukotriene receptor antagonist or theophyline
Tim is a 6 year old with asthma. He has a salbutamol inhaler and is also on 200 micrograms of inhaled steroids BD as well as monteleukast. He is still experiencing symptoms. What is the next step in the management of chronic asthma in someone of his age group (5-12)?
Increased inhaled corticosteroids to 400 micrograms BD (800/day)
Tim is a 6 year old with asthma. You recently increased his dose of inhaled corticosteroid therapy from 400 micrograms a day to 800 micrograms a day. He is still experiencing symptoms. What is the next step in the management of chronic asthma in someone of his age group (5-12)?
Refer to specialist care
You prescribe salbutamol inhaler with a spacer for Alice a 3 year old with newly diagnosed asthmatic. She comes back 3 weeks later and her symptoms do not seem to have improved enough with the reliever. What is the next step in the management of chronic asthma in someone of his age group (under 5)?
Inhaled corticosteroids - beclometasone 200-400 micrograms per day normally across two doses
Alice is a 3 year old with asthma. She has a salbutamol inhaler and has recently been started on inhaled steroids. However, she is not tolerating these particularly well. What might you prescribe for Alice instead of the inhaled corticosteroids?
Leukotriene antagonists - monteleukast
Should only be given to children older than 2
Alice is a 3 year old with asthma. She has a salbutamol inhaler and is also on 200 micrograms of inhaled steroids BD. She is tolerating these well but is still experiencing symptoms. What is the next step in the management of chronic asthma in someone of his age group (under 5)?
Consider starting Leukotriene antagonists - monteleukast if symptoms are still uncontrolled when using an ICS at 400 micrograms/day.
Should only be given to children older than 2
